13. Gender and HIV/AIDS Using Media for Behavior Change Communication in Hausa-Islamic Society

Binta Adamu Suleiman

The HIV/AIDS epidemic in Nigeria has extended beyond the commonly classified high-risk group into the general population. More than 3.5 million people aged 15-49 years are now infected with the virus. However, Women are particularly hard hit by the epidemic; an estimated 58% of the infected population are girls aged 15-24 years (NSF, 2004). HIV/AIDS is having a devastating impact on African Nations, particularly on the country’s women and poor people. It is estimated that 80% of all HIV positive women live in Sub-Saharan Africa (Orubuloye, Caldwell, & Caldwell, 1993). This chapter examines the ways in which gender inequality increase Hausa Women’s vulnerability to HIV/AIDS infections, particularly the role played by traditional, sociocultural, and religious factors in intensifying those risks. The media in Nigeria has been of tremendous help in efforts to educate the public about HIV/AIDS. However, they are severely limited by an array of conflicts and complexities about the nature of mass communication profession on the one hand and public health information on the other. This paper argues that the vast potential of the media in behavior-change communication for HIV/AIDS prevention has not been fully exploited. Even if it were, HIV/AIDS prevention programs must go beyond information and knowledge for empowerment. These programs must look at the disproportionate ways men and women are affected by the epidemic and adopt a short-and-long term objective that addresses not only the disease but its major drivers. These drivers include gender inequality and poverty. The success of HIV/AIDS campaigns in Nigeria, therefore, demand a carefully designed and well formulated strategy for woman empowerment, which ultimately curbs the spread of the disease and makes way for a healthier Nation.

Conceptual Framework

Response to HIV/AIDS in Nigeria has shifted from a health sector to a multi-sector response that focuses on prevention, treatment, and mitigation of impact intervention as distinct components. More recently, the HIV/AIDS National response plan has tried to mainstream gender into all aspects of its intervention program. The HIV/AIDS response plan in Nigeria uses four different avenues for its prevention campaigns, these are: Mass Media, entertainment, education, community, mobilization, and Interpersonal Communication.

The mass media component is only one component, yet it is the most significant because the media has a pervasive influence in almost all aspects of personal and community relations. Its social role cannot be limited to health matters. Mainstream or conventional media have traditionally been used to disseminate information about HIV.AIDS, usually using spot advertisements, sponsored programs, PSAs, etc. This involves huge capital expenditures; and, indeed, substantial resources have been committed to HIV/AIDS prevention and treatment. Awareness of the disease has reached 80% among Nigerians. Nevertheless, the number of fresh infections continues to rise, suggesting that information has not led to behavioral change. The central coordinating body on HIV/AIDS in Nigeria, the National Action Committee on AIDS (NACA), bases its behavioral change program on two slightly modified theories. The Information, Motivation, and Behavior skills model (IMB) and Extended Parallel Process model (EPPM).

The IMB model specifies that information and motivation work primarily through behavioral skills to influence HIV/AIDS preventive behavior. This model was slightly modified to include four broad determinants of behavior change: information, motivation, behavioral skills, and social/community support.

The EPPM model is a health behavior change theory that focuses on how to channel fear-protective direction rather than negative-maladaptive direction. This model promotes two appraisal processes. The threat appraisal, where individuals evaluate whether or not they are susceptible to the threat and/or whether or not the threat is serious. If a positive threat is perceived as either trivial or irrelevant, then the message is not processed any further. There is no response to the campaign. If a threat is seen as serious and relevant, however, people become frightened and motivated to act. Then efficacy appraisal occurs, where people evaluate the recommended response in terms of self-efficacy, e.g. Am I able to protect myself against HIV/AIDS infection? and response efficacy e.g. Does the recommended response work?

If people believe themselves able to perform an action that effectively averts a serious and relevant threat then they are motivated to control the danger by engaging in self-protective actions, like condom use. In contrast, if they feel unable to perform a recommended response or they believe the response to be ineffective, e.g., condoms do not work or they have holes in them, then they give up on trying to control the danger and instead control their fear. They do this by denying their risk of HIV/AIDS infection, defensively avoiding the HIV/AIDS issue or perceiving manipulation, e.g., AIDS is a hoax or a government plot (National Action Committee on AIDS, 2004). These two models form the conceptual framework for behavioral change communication for HIV/AIDS in Nigeria.

Behavioral change models are popularly used as theoretical grounding for most prevention and behavior change interventions, such as the health belief model, Prochaska’s stages of change model, theory of reasoned action, hierarchy of effects model, agenda setting model, spiral of silence model, etc. have been questioned by many scholars. Singhal and Rogers (2003), point out that the models make at least four mistaken assumptions. They assume that all individuals are capable of controlling their context, whereas the ability of individuals can get access to condoms, but getting HIV tests etc, are con but trolled by cultural, economic, social, and political factors over which they have no control. The theories assume that all individuals are on an even playing ground, can make rational decisions about their lives, and possess free will. Gender inequality clearly inhibits a woman’s ability to control when, where, or even how she uses condoms.

Singhal & Rogers (2001) also contend that well-informed rational decisions or intentions to use condoms can often fall by the wayside during a passionate sexual encounter. Physiological urges for sexual release may overwhelm previously conceived rational intentions about safe sex. The main flaw in the use of these behavior change models is that they target the individual, whereas behavior in some contexts is communally inspired or determined. Freimuth (1992), Yoder (1997), and Airhihenbuwa and Obregon (2000) argue that the flaws in the application of the commonly used classical models in health communication are a result of contextual differences in areas where those models are applied. Airhihenbuwa and Obregon (2000) posit that most of the differences in health behaviors are often a function of culture. Culture, they contend, needs to be exposed, deconstructed, and reconstructed so that new positive cultural linkages can be formed. Similarly, McKinlay and Marceau (1999, 2000) and Salmon and Kroger (1992) posit that it is time to move away from individual-level theories of health behavior to more multi-level, cultural, and contextual interventions. Singhal and Rogers (2003), citing Brummelhuis and Herdt (1995), Moses et al (1990), and Parker (1991) support this position adding that communication strategists often negatively viewed culture as static and mistakenly looked upon people’s health beliefs as cultural barriers. Culture has often been singled out as the explanation for the failure of HIV/AIDS interventions.

Thus, community organization theory, alongside IMB and EPPM models, would more effectively work for HIV/AIDS prevention intervention programs. Community organization theory has its roots in theories of social networks and support. This theory emphasizes community participation, where communities with common problems come together, determine their common objective, mobilize the needed resources, and develop and implement strategies for reaching their goals. This theory can be successfully used along with social learning theory and has many alternative change models: locality development, social planning, and social action. Whichever change model is adopted, the key concept remains the same. The process of empowerment is intended to stimulate problem solving and activate community members. Community competence is an approximate community-level equivalent of self-efficacy plus behavioral capability, which are the confidence and skills to solve problems effectively.

Participation and relevance go together: they involve citizen activation and a collective readiness for change. Issue selection concerns identifying “winnable battles” as a focus for action and critical consciousness stresses the active search for root causes of problems. (Rothman & Tropman, 1987). Since gender inequality specifically fuels the epidemic, women’s health advocates could use social action to pressure powerful institutions to address their rights, using media advocacy as a tool in their efforts. Social action is the strategy that women and other disadvantaged groups need to negotiate a fair and gender sensitive society through community participation.

Nigeria: Demographic Situation

Nigeria is the largest country in Sub-Saharan Africa and the tenth most populous nation in the world. It has a landmass of 923,768 square kilometers, a population density of about 96.3 persons per square kilometer and is predominantly rural. As of 2006, the population of Nigeria is 140 million, about half the population lives in the Northern part of the country. The life expectancy increased from 45 years in 1963 to 51 years in 1991; partly due to the effect of HIV/AIDS epidemic, life expectancy dropped to 47 yrs in 2001 (Federal office of statistics, Abuja). Nigeria is made up 36 states and a Federal Capital Territory, FCT. The Northern part of Nigeria is predominantly populated by Hausa Muslims. There are other linguistic and ethnic groups found within this zone, such as Dakarkari, Kambari, Dandawa, Dukkowa, Kaje ,Kataf, etc. The Hausa language, however, remains the region’s main language of communication. Hausa identity is also an Islamic identity. A true Bahaushe (Hausa-man), Phillips (1989, p. 40) contends, is a Muslim, pointing out that Hausa speakers who maintain their pre-Islamic beliefs are referred to as Maguzawa. Indeed, one common means of expressing conversion to Islam is “Na Zama Bahaushe,” meaning (I have become a Hausa person). Khalid (2001) notes that Hausa ethnicity is a complex of variables involving language, religion, and even descent. Islam is the dominant religion in the North particularly among the Fulani, Hausa Zabarmawa, and Dandawa. Some ethnic groups, especially in the Kaduna and Kebbi states and migrant groups from the Southern part of Nigeria, also practice Christianity. Some small groups of traditional religious worshippers can be found across the ethnic divide.

HIV/AIDS in Nigeria

The first AIDS case was reported in Nigeria in 1986; since then, the epidemic has been growing at an alarming rate. The adult sero-prevalence rate has increased from 1.8% in 1991 to 4.5% in 1996 and 5.0% in 2003 (NARSHS, 2003). Estimates using the 2003 HIV/Syphilis sero-prevalence sentinel survey among women attending ante-natal clinics reveal that between 3.2 and 3.8 million Nigerians aged 15-49 may be living with the virus. With the adult prevalence rate at 5.0% as of 2004, the nation is at the threshold of an exponential growth of the epidemic. All states in Nigeria are affected by the disease, though the severity differs. In some states, the prevalence rate is as high as 10%. The infection cuts across both sexes, youths between ages 20 and 29 years old are more affected and urban cities record higher prevalence rates than rural areas—although this may be due to under testing or under diagnosis due to poor health facilities in rural areas. Heterosexual transmission remains the predominant method of infections, as in other parts of the world where it is estimated to account for up to 70% of infections (Oleary & Jemmot, 1995, p. 220), although more and more children are getting infected via Mother to Child (MTC) transmission, while more children are losing both parents to the disease (NSF, 2004).

Gender and HIV/AIDS

According to Roger (1991, p. 231), until recently women were missing persons in the AIDS epidemic, partly because AIDS was initially defined as a gay disease. As incidences of HIV increase among women from all segments of the population in all parts of the world, attention has finally turned to understanding the factors that put women at risk and working to decrease the number of infections. In Nigeria, the epidemic’s disproportionate impact on women and girls has risen to a startling new reality: the feminization of the epidemic, rooted in women’s economic dependency, stigmatization, and denial of their rights (NSF, 2004). The last situation report from NACA shows that the AIDS epidemic poses a severe challenge to the human rights of young women and girls. Gender inequalities, which exist within the Nigerian society, give room for the epidemic to grow. The lower status of women decrease their ability to make choices, including those related to their reproductive health. Women’s subordinate status in society makes them unable to negotiate safe sex, to seek care, or fight the stigma associated with the infection. Their economic powerlessness drives some women to commercial sex, which put such women in high-risk categories. The network nature of HIV/AIDS infection at present has actually made the notions of high-risk groups obsolete.

There are factors that are universally identified as putting women at higher risks of HIV infection than men. Raffaeli and Pranke (1995, p. 220) categorizes those factors into three distinct groups: biomedical, epidemiological, and sociocultural. Women’s bodies are physiologically more vulnerable to HIV/AIDS in certain cases. Male to female transmission of HIV is naturally more efficient than female to male (Brunham & Ronald, 1991) Padian, Shibowski, and Jewel (1991) also reveal that the sperm contains more HIV viral load than vaginal fluids and because sperm that is deposited in women’s bodies stay for longer periods, the chances of infection are higher for women. In addition, women’s mucosal surface is greatly exposed during intercourse, and while many sexually transmitted diseases remain asymptomatic or undiagnosed, they increase the chances of infection (Merson, 1993; Wasserheit, 1992).

Epidemiological analysis shows that women are more likely to require blood transfusions related to childbirth, abortion, or miscarriage. Debruyn (1992) states that women are more likely to partner with older men, who have had previous sexual encounters. Further HIV positive women progress to illness faster when they are pregnant or at child delivery.

Sociocultural factors such as belief about sexual behavior and gender roles, the tendency to engage in commercial sex work, and nonconsensual sex aggravate the woman’s vulnerability to HIV. Weiss and Gupta (1993) and Heise (1992) also show that norms of masculinity ensure that boys are granted sexual freedom and girls are conditioned to value virginity. Boys are unnecessarily exposed to HIV even while trying to prove that boys will be boys. At this point, one must ask the specific Hausa traditions and cultural practices that increase a woman’s vulnerability to HIV infections.

The Context and Conception of Gender in Hausa Islamic Society

In Hausa Society, gender and sex are two sides of the same coin. The notion that gender is socially constructed, and thus subject to deconstruction, is seen not only as problematic but also un-Islamic. The serious resistance that women encounter when they try to explain gender as a social construct merely proves that questions of conceptualization are questions of power and at the very root of women’s oppression. To see how gender relations take place in Hausa society, the private and public spheres would provide a good entry point. Gender relations in Hausa families are patriarchal, with a strong male influence on every sphere of life. Marriage, childbearing, and child rearing is the ultimate for a woman. The ideal woman and wife in Hausa society is viewed as submissive, obedient, and content to enjoy reflected status from her husband (Khalid, 2001). A married woman is completely under her husband’s control. He makes final decisions on all family matters and has control over his wife’s (wives’) movements, her economic activities and with whatever it is she becomes involved. In a typical Hausa Islamic family, men are in control. This means that any message for safe sex directed at a Hausa wife may not succeed, unless the man agrees to cooperate. The decision to practice safe sex, use condoms, or remain faithful is not within a woman’s jurisdiction.

Hausa women do not actively participate in the public scene; kulle (wife seclusion) is still widely practiced. Hausa women’s labor force participation is less than 10%, based on the 1991 Nigerian census. Though there is a high degree of informal economic activity within the homes, which in some cases even supplement the man’s income or in extreme cases even feeds the family, but which has remained largely undocumented and undervalued. When women get into formal employment, the same inequality that they experience in the home is, in most cases, transferred to the work environment and is used to determine women’s career patterns and the type of work to which they are limited, in order not to lose their femininity. Vocal and assertive women who insist on equal treatment are branded as loose, improper, or uncultured. The norm of submissiveness to men’s authority is enforced both within and outside the home. Change is taking place with increasing access to education, but it is too gradual to be noticeable.

Other Factors Which Increase Vulnerability to HIV/AIDS

In Hausa culture, which is largely defined by the Islamic tradition, women are considered men’s responsibility. Less than 20% of women actively participate in the formal employment sector (Suleiman, 2004). Most of woman’s contribution to the informal economy, though acknowledged, remains undocumented, largely because work is defined as paid employment. Most Hausa women are forced to depend on their husband or family. This dependency aggravates female poverty. Where a woman loses a spouse through death or divorce, life takes a new turn and a woman has to find other means of survival, which may involve exchanging sex for money. Poverty increases HIV risk. According to Amaro (1988), Marin and Marin (1991), and Nyamathi and Vasquez (1989) the stresses and difficulties associated with poverty may displace HIV on a scale of priority concerns. In the US, about 73% of mothers who are HIV positive have children who receive public assistance.

The Hausa’s being largely Islamic also practice polygamy. The system is perhaps the most abused Islamic injunction in Hausa land. Islam has specified the conditions that must be satisfied before a man takes another wife, the most important being his ability to adequately provide for all the wives. However, the poor in Hausa society practice polygamy the most. This intensifies family poverty, which is a strong factor that drives the AIDS epidemic. Hunter (1994) has found that women who have had more than one sexual partner are two to five times more likely to be infected with HIV than those who have had only one sexual partner. This shows the risks associated with polygamous marriages. However, Islam has prescribed polygamy for some men under certain conditions. Nevertheless, there is a lack of constituted authority to enforce these conditions. Women rejoiced at the reintroduction of Shari’a in some states, thinking that it would bring sanity into some oppressive practices like arbitrary polygamy. However, that has turned out to be wishful thinking, as most of the focus of Shari’a has been directed at women and what they can or cannot do. Serious developmental issues that affect women have been marginalized while very personal issues, like modes of dressing, are elevated to state matters. In Kano state now, for example, young girls and women have to wear Arabian style Hijab before going to the office or school, even six-year-old girls are not spared. This writer is witness to a case in which a man aged 42, married at least four wives in a year and divorced all four before the year ended in readiness to marry another set of four before the Ramadan period started. These serial divorces will lead to remarriages and thus increase the incidence of multiple partnering, which increase vulnerability to HIV/AIDS.

Hausa culture places the burden of holding a marriage together almost exclusively on the woman. If a marriage fails, it must be the woman’s responsibility, so most women try to make it work at all costs. For example, there is a big market for sex enhancing drugs, which women use especially in polygamous relationships, in the belief that using such drugs will make them the most favored wives. However, most of these drugs are required to be inserted deep into women’s vagina. In some cases, the drugs do not conform to minimum standards of hygiene, which may lead to infections. These infections increase a woman’s risk of HIV infection. Similarly, early marriage in some girls make sexual debut very difficult, painful, or even impossible. When that happens, a local surgeon known as Wanzami is called to remove the Angurya (obstacle) from the girl’s private part, several men are required to hold the young woman down and the obstacle is crudely removed without anesthesia or painkillers. This practice leads to terrible consequences from uncontrolled bleeding to shock or even death. The same Wanzami is called upon to circumcise newborn babies. Boys are circumcised to improve their reproductive abilities and their sexual performance; for girls, the objective is to diminish their sensitivity to sex. Here we see a cultural orientation that condones male sexual adventurism and female sexual restraint. For males, this masculinity norm renders them more vulnerable to HIV. Local surgeons and traditional birth attendants are being constantly educated on sterilization methods; their adoption of such techniques on a wide scale has not yet been documented.

Young girls from the age of 15 to 24 are the most vulnerable group among women. A practice whereby young girls from villages come to town to work as domestic servants further increases that risk. Most of these girls are from poor families; their income is sent to their parents who, in most cases, use the resources to maintain themselves. The girls face a lot of maltreatments, violence, and rape from their host families. Sometimes they run away into prostitution. To halt this practice, the government of Kano established schools for girls in Madobi village in Kano. Unfortunately, the parents refuse to take their children to school, claiming that schools do not bring in cash but domestic service does. For instance, in Kubarachi village in Kano, more than ten girls were said to have returned home with unwanted pregnancies. Due to poor medical facilities and apathy towards HIV testing, it is difficult to know how many of them may have contracted the disease in addition to being pregnant. Young girls are being introduced to anal sexual practices by homosexual men, this practice attracts as much as fifty thousand Naira and some university students from poor families just cannot resist.

Childbearing is the ultimate dream of every Hausa woman and, in fact, is a factor that keeps most marriages intact. Prevention of mother to child infection requires that a HIV positive woman should not breastfeed her child. Fear of stigma and of losing her man may prevent women from taking a doctor’s advice not to breastfeed, with dire consequences. These norms and practices, which are deeply embedded in culture, and which contribute to grueling poverty, combine with stigma, norms of masculinity, and motherhood to increase women and men’s vulnerability to HIV infection. In the absence of a cure for HIV, prevention is the only hope. This shows that preventive interventions could be effective only when the factors that fuel the HIV/AIDS epidemic are concretely addressed. Levine, Britton, James, Jackson, Hobfall, and Levin (1993) and Oleary and Jemmot (1995) have also noted that female empowerment is the ultimate requirement for success in HIV risk reduction. Given that changes in gender roles require longer process, in the short-term women need skills in HIV prevention, especially in negotiating condom use with their partners. The ABCs of HIV prevention have since proven problematic for women, especially poor women; there is need for development of a preventive method that is unobtrusive and permits conception while inhibiting HIV.

Role of Media in Behavior Change Campaigns

Mass Media in Nigeria along with other methods of communication has been used to raise AIDS awareness and knowledge and to induce behavioral change. AIDS awareness is currently at about 80% and knowledge of condom use among males at 70% and among females at 54%. However, NACA has graciously admitted that the high awareness has not been matched with safe sex practices (condom use among males and females is 23% and 8% respectively). This is not surprising because several factors affect the efficacy of campaigns and, in most cases, it is not the number of resources spent on campaigns, but the way planning and execution is carried out. Huszti, Cloptan, and Mason (1989) found that although health messages increase knowledge and positive attitudes towards patients with AIDS, they do not appear to have a positive effect on attitudes towards practicing sexual behaviors that would prevent the spread of HIV.

Interpersonal communications, such as small group discussions, have been found to be more effective in changing attitudes towards high-risk behavior. Homans and Aggleton (1988) concur and point out that such methods are more effective than impersonal media campaigns because they impart information by word of mouth and contact. A combination of different strategies such as mass communication, interpersonal, entertainment education, and community mobilization and support have been used for public health communication; still, behavior change remains very low. One must wonder why that is the case.

At the level of community mobilization, government and about 700 NGOs and CBOs are said to be actively mobilizing support for HIV/AIDS interventions. In the North, religious groups have been identified as obstacles to the fight against HIV/AIDS. As such they are largely ignored in most cases. In fact, some international aid organizations specifically do not deal with religious groups, claiming that they are not missionaries. This isolation, which the religious leaders experience, may have constituted a big obstacle for HIV/AIDS interventions. The Hausa society is not a secular institution, no matter what the Nigerian government would have us believe. Religious leaders are very influential in Hausa society and the most respected ones are role models to a vast majority of people. No successful campaign could succeed in the North without the full participation of religious groups.

Enter-educate strategies in the North may not work effectively if it relies only on infrequently held programs based mostly in the cities. Every culture has its own idea of entertainment. HIV/AIDS prevention programs in Hausa society would do well to exploit local avenues of reaching the people, avenues that have been used in the past. Every age group in society has its own specific interest. For example, young girls in most Hausa speaking states have shifted their interest from reading Mills and Boons to locally authored love story novels popularly known as Kano market literature or soyayya (love) novels. Entertainment Education would only succeed when based on a community’s idea of entertainment.

Although mass media is not the only medium for behavior change communication, its potential for instant messages to widely dispersed and heterogeneous audience has not been fully utilized in HIV/AIDS prevention. Most countries that have used the media successfully for HIV/AIDS prevention intervention, such as South Africa’s Soul City, the “Islamic jihad against HIV/AIDS in Uganda,” Twende Na Wakati in Tanzania, Thailand’s condom program, etc. went for all-out media campaigns. In Nigeria now, it is very common to listen to hours of radio programming without reference to HIV/AIDS either as a PSA, an advertisement, or as part of a continuity program. There are public health messages, but the frequency simply has not matched the severity of the disease.

Messages over the radio and TV in Nigeria do not target any particular group and are in some cases quite counterproductive. Stockdell and Farr (1987) and Stockdell, Dockrell, and Wells (1989) studied the message conveyed by HIV/AIDS posters and discovered that posters carried different meanings depending on who read them. In Kano, the photographs of a popular film actress, Fati Mohammed, was used on a billboard; she was shown beautifully smiling to the camera on a big, well-lit billboard, the message in Hausa was “You cannot know who has HIV/AIDS by mere looks” (Ba a gane mai cutar kanjamau a fuska). However, the message had different interpretations and some people actually thought the actress was HIV positive. The lesson here is that it is wasteful to direct HIV/AIDS messages at everyone. The efficacy of campaigns may well depend on proper targeting of at-risk groups.

Targeting AIDS messages is made more difficult by the multi-ethnic and multi-religious mix of the population as well as a lack of active decentralized HIV/AIDS programs. Most NGOs are based in urban centers and the federal capital, Abuja. Ratzan (1993) notes that most communication activities are not guided by an effective strategy, so resources are used inefficiently. Singhal and Rogers (2003) concur and cite more reasons for the failure of communication programs. They note that, most communication programs are not grounded in formative research findings and many communication activities are not culturally appropriate and may be found offensive, which is easy to do when dealing with a sensitive topic like HIV/AIDS that involves stigma, sex, and death. In short, Singhal and Rogers (2003) contend that most communication interventions are flying blind. In AIDS campaign literature circulating in Hausa states—mostly originating from Abuja and from some international donor Agencies, it is common to come across words like “negotiating sex,” “condom use,” and “marital rape,” “Sex worker,” etc. Muslim Hausas cannot contextualize these terms. There is no negotiating sex in the life of a Muslim, commercial sex is not work. Further, if the message is really about AIDS, the people contend that is is an assault on their sensibilities. In the final analysis, this type of content breeds suspicion for the integrity of message source, deepens the them versus us mentality, and on the whole, creates the impression that the message is not about them. Active community involvement is the only panacea to this problem.

Certain factors also constrain the media in discharging their social responsibility. Journalists and media personnel lack adequate capacity to report HIV/AIDS issues accurately. Most Nigerian journalism schools have no courses in health reporting, in fact most journalists in key positions in media organizations learned on the job. Prevention interventions are very expensive projects and resulting evaluations can be very difficult; most governments prefer service delivery to prevention.

Channel selection also affects prevention campaign efficacy. In the North, as in other parts of the country, every group could be identified with a particular media. The phenomenon of Hausa films has created a new captive audience. The audience is largely made up of women and youth of different age groups. The coming of Hausa films/home videos has revolutionized the visual entertainment culture of Hausa people, to the extent that, Indian Films and Western films now compete for attention with locally produced Hausa home videos. Jibril (2004) observes that beyond the usually pirated western TV programs, feature film, and pornography, Nigeria is reaping some benefits from what amounts to decentralized TV programming. Small-scale video operations have emerged, permitting local artists to package materials for the Nigerian home video market.

HIV/AIDS has become a poor people’s epidemic. Poor people in Hausa society are found predominantly in rural than urban areas. Women and youth are classified as at-risk groups, the technology of home video much more than any other conventional mass medium, like TV or Radio, has greater potential to access these target groups with HIV/AIDS behavior change communication. Jibril (2004) points out that these new forms of film screening (Hausa home videos) environments, which are normally housed in residential quarters, provide an unconventional channel of content distribution to a much larger audience. The low socioeconomic status of the urban poor of Northern Nigeria made the existence of these forms of squatter cinema walk-ins possible in Northern Nigerian cities. However, so far only two home videos have been produced with HIV/AIDS themes as at April 11, 2005. These are: JAN KUNNE, 1, 2, 3, sponsored by a United States International Aid Agency (USAID), and MALAM KARKATA, whose release has been delayed by controversy between the producers and the film censor board.

Other than films, there are other cultural avenues for information dissemination, such as Hausa songs produced for Hausa home videos, but which are released and marketed prior to the release of the actual films. There are Islamic musical groups known as Mandiri (drumbeaters), very popular in Muslim dominated cities especially Kano, Katsina, Daura, and Zaria, and whose songs are marketed in cassettes and video formats. In addition, they draw large audiences and are now used for entertainment at wedding receptions, naming ceremonies, and other traditional festivities. All these provide cheaper alternatives to conventional media and are more acceptable to the people.

The mass media in Northern Nigeria is also vibrant, but not as vibrant as the southwestern media. The few private stations that have been granted licenses to operate are doing a lot of work in health education. It should be noted that mass communication process and the goals of public health information may be at cross purposes. Unless there is a spirited attempt to harmonize their objectives, the media’s potential may not be effectively harnessed. This could be the missing link between HIV/AIDS awareness efforts and the lack of appreciable success in achieving behavior change. Journalism and media responsiveness to health issues depend on a number of factors that public health officials may not find comfortable. Mass media operations are shaped by market demands, consensus and competition within the news community, and pressure from advertisers. The public health officials want to stop smoking. Media organizations on the other hand need tobacco advertising revenue to survive; the only way to strike a balance is to find means of generating revenue without compromising socially responsible ethics. In developing countries, a developmental approach to communications is most ideal. There have been instances where the media has actually served as an obstacle to behavior change communication. For instance, in advertising there are all sorts of herbal cures for HIV/AIDS, they do more damage than good by creating false hope.

Conclusion

This chapter has identified and discussed sociocultural and other factors that increase women and men’s vulnerability to HIV/AIDS infection. Some of the major obstacles to behavior change communication for HIV/AIDS in Northern Nigeria have been identified. The role of mass media in public health communication for behavior change cannot be over-emphasized. However, HIV/AIDS prevention campaigns’ efficacy depends on, among other factors, proper targeting and tailoring of messages and channel selection. Many local entertainment-education opportunities exist for incorporation into the HIV/AIDS campaigns, and they need to be strengthened and utilized more often, because they are affordable, accessible, and more flexible than mainstream media. It is also pertinent to understand the cultural differences between communities and to exploit the opportunities that culture advances rather than perceive it as an obstacle. Singhal and Rogers (2003) documented the Green Pendelu campaign in Mali, which illustrates that for health projects to be effective, the cultural beliefs and practices of the targeted communities need to be thoroughly understood. Only then can communication strategies accentuate the positive undercurrents of a culture, reducing or completely overcoming the effects of opposing forces. The focus should be on creating the enabling environment for media messages to prompt recipients to adopt safe sex behaviors. In particular, poverty reduction and women empowerment interventions would greatly halt spread of the disease. Health communication efforts must be horizontal, community driven, culturally relevant, and sensitive for maximum efficacy. Health communication needs to be integrated into journalism schools’ curriculum. In the same vein, media personnel need training and reorientation in development communication.

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